Peroneal Tendinitis

Anatomy

The peroneal brevis and peroneal longus are two tendons that originate as muscles in the lateral compartment of the leg. The peroneal tendons course around the outside of the ankle behind the lateral malleolus. The peroneal brevis tendon inserts into the 5th metatarsal base while the peroneal longus tendon inserts into the1st metatarsal base. The peroneal tendons are responsible for everting the foot. They also help to stabilize the foot and ankle and protect against ankle sprains.

Condition

Peroneal tendinitis occurs when there is inflammation along one or both of the tendon sheaths and/or tears along a portion of the tendon. This can result in ankle instability, pain, or elevation of the arch of the foot.

Symptoms

Pain can be felt along the entire course of the tendons

Swelling

Tenderness along the involved tendon

Heightening of the arch of the foot

When there is an injury to the peroneal fascia, the tendons can subluxate. This felt as a popping or dislocation of the tendons along the outside of the ankle

Diagnosis

Diagnosis is made by a comprehensive foot and ankle exam by Dr. Stewart along with x-rays of the foot. Imagining studies such as ultrasound and MRI are sometimes required to determine the extent of tendon injury.

Common causes

Overuse, which means there is too much physical activity. This commonly occurs in runners and/or walkers and in such sports as soccer, lacrosse, basketball, tennis, and football

Individuals with a high arch foot are at greater risk of rolling the ankle therefore injuring the peroneal tendons

Although less common, the condition can occur acutely in weekend warriors

Treatment

Peroneal tendinitis generally takes 6-8 weeks to improve and early activity on a healing tendon can result in a set back in recovery. Non-compliance can double the recovery time and can be very frustrating for patients.

Early and aggressive conservative treatment is recommended to prevent further tendon injury. Dr. Stewart terms peroneal tendinitis a pro-active condition. Although we can never offer a 100% guarantee, the majority of Dr. Stewart’s patients improve with conservative (non-surgical care).

Conservative treatment for peroneal tendinitis includes:

Immobilization of the foot and/or ankle. Depending on the severity of the condition, this may require cast immobilization with crutches, a walking boot, a hinged ankle foot orthosis with supportive shoe gear, a multi-ligamentous ankle brace with supportive shoe gear, or custom foot orthotics with supportive shoe gear

Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise; recommended exercises include circuit training, swimming, and bicycling